Provider Demographics
NPI:1609171438
Name:ANDRUSCAVAGE, CHRISTOPHER JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOHN
Last Name:ANDRUSCAVAGE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 H ST
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:WA
Mailing Address - Zip Code:98230-4021
Mailing Address - Country:US
Mailing Address - Phone:360-332-1086
Mailing Address - Fax:360-332-6071
Practice Address - Street 1:245 H ST
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:WA
Practice Address - Zip Code:98230
Practice Address - Country:US
Practice Address - Phone:360-332-1086
Practice Address - Fax:360-332-6071
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor